Ob-Gyn Coding Alert

Stay vigilant: This new symbol could trigger important guideline changes.

In this year of constant COVID-19 diagnosis changes and major E/M coding transformations, you wouldn’t be alone if you’re worrying you’ll have a bunch of new ob-gyn CPT^® codes to implement as well — but you can breathe a sigh of relief. The updates for ob-gyn practices are minimal, but that doesn’t mean you can let down your guard. Missing tiny details could spell disaster for your claim, so make sure you know what affects you as of January 1, 2022.

Breakdown: You’ll find more than 400 new, revised, and deleted codes for 2022. Check out this quick rundown on all the CPT^® changes you’ll need to know to optimize your ob-gyn coding in 2022.

Remember: “Keeping abreast of code changes can be important to your practice’s bottom line,” says Melanie Witt, RN, MA, an independent coding consultant from Guadalupita, New Mexico.

Keep Your Eye on 99211 — Here’s Why

First of all, CPT^® 2022 applies some new verbiage to 99211’s code descriptor. This change might appear superficial, but the AMA doesn’t make changes to descriptors for no reason. Make sure you pay attention to this revision — no matter how trivial it seems — as a single different word in a code descriptor could mean a world of difference on a claim form.

Code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.) will have a small descriptor change. CPT^® 2022 deletes “Usually, the presenting problem(s) are minimal.”

Heads up: However, here’s what is especially interesting. Code 99211 will carry a telemedicine symbol to indicate you can bill it if the criteria is met, “but keep in mind this code does not require the presence of a physician, so billing rules on use of this code may be restricted — even for telehealth,” Witt says. “If Medicare publishes any guidelines for this code, pay attention.”

Check Out 11981’s Revision, Too

Code 11981 (Insertion, non-biodegradable drug delivery implant) will undergo a revision, too. The current code descriptor will change to “Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable).”

In other words, you’ll have “no change in use of the code for Implanon, but the definition broadens the type of delivery implant to include biodegradable and bioresorable types. I know there have been some studies of making a 3D printable drug implant for hormones, but it is still in the research stage. That type would be biodegradable,” Witt explains.

Strike Off 59135 as of Jan. 1

As of January 1, you will have one less option to use for when an ob-gyn treats an ectopic pregnancy. You will delete 59135 (Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy).

“I assume if a hysterectomy is required due to this type of ectopic, you would bill it separately using the type of hysterectomy performed,” Witt suggests, but adds, “I would wait for the CPT^® code changes book to verify this was the rationale.”

You Will Have a New Supply Code

You will also have the addition of a new supply code, and that code is 99072 (Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other nonfacility service(s), when performed during a Public Health Emergency, as defined by law, due to respiratory-transmitted infectious disease).

However, it remains to be seen whether your ob-gyn will use this code. “An ob-gyn practice may use this code, but I think it was intended for internal medicine/general medicine/primary care practices that are dealing with COVID patients,” Witt says.

Don’t Forget About Category III Codes

“Category III codes are not reviewed by the Relative Value Scale Update Committee (RUC) and do not receive payment valuation,” says Michael Weinstein, MD, a physician in Washington, D.C., and former member of the AMA’s CPT^®’s Advisory Panel. “They are often considered ‘experimental’ services by insurance carriers and therefore will not be considered a covered benefit. A claim for payment will usually be followed by a denial which can be appealed,” he adds.

Even so, CPT^® guidelines strictly mandate the utilization of these Category III codes when they are specifically created for the procedure your ob-gyn performs. CPT^® also specifies that a Category III code should be opted over an unlisted procedure code under Category I.

You have numerous new Category III codes for a donor hysterectomy. They are:

• 0664T (Donor hysterectomy (including cold preservation); open, from cadaver donor)
• 0665T (Donor hysterectomy (including cold preservation); open, from living donor)
• 0666T (Donor hysterectomy (including cold preservation); laparoscopic or robotic, from living donor)
• 0667T (Donor hysterectomy (including cold preservation); recipient uterus allograft transplantation from cadaver or living donor)
• 0668T (Backbench standard preparation of cadaver or living donor uterine allograft prior to transplantation, including dissection and removal of surrounding soft tissues and preparation of uterine vein(s) and uterine artery(ies), as necessary)
• 0669T (Backbench reconstruction of cadaver or living donor uterus allograft prior to transplantation; venous anastomosis, each)
• 0670T (Backbench reconstruction of cadaver or living donor uterus allograft prior to transplantation; arterial anastomosis, each)

Impact: “I have no idea why these were added but it must be a new thing for a woman or a deceased person to give a woman her uterus in hopes the recipient can conceive. Lots of issues here I would imagine, not the least being insurance coverage,” Witt says.

The Category III codes don’t end there. You’ll also have a new code for the treatment of female stress urinary incontinence (SUI), which is:

• 0672T (Endovaginal cryogen-cooled, monopolar radiofrequency remodeling of the tissues surrounding the female bladder neck and proximal urethra for urinary incontinence)